For a long time, insurance providers did not understand that mental health and substance use disorders (SUDs) are just as important as physical health. Going without effective treatment for these disorders can be crippling and even life-threatening.

What’s a Co-Occurring Disorder?

insurance coverage for addiction treatment

If you have a SUD, there is a good chance that you have an underlying mental condition. People who become dependent on alcohol or drugs have frequently started misusing substances as a way to medicate themselves. 

According to the Journal of the American Medical Association, 37% of alcohol abusers and 53% of drug abusers also have at least one serious mental illness. This is a co-occurring disorder, also known as a dual diagnosis, and both disorders must be treated at the same time.

Mental Health Parity and Addiction Equity Act (MHPAEA)

One of the many important aspects of both the Affordable Care Act and the Mental Health Parity and Equity Act is to make sure that health plans and insurers offer substance use disorder and mental health benefits. And these benefits must be equal to or better than the coverage for surgical and general medical care.

A survey by the American Psychological Association found that nearly 90% of Americans had not heard about the MHPAEA. This law applies to most employer-provided plans and individual plans bought through the new federal and state health insurance exchanges.

All plans must cover:

  • Behavioral health treatment, such as counseling and psychotherapy treatment.
  • Mental and behavioral health inpatient services.
  • Substance use disorder treatment. 

Depending on your state and the health plan you have, some behavioral health benefits may vary. Some providers cover part or all of the costs of rehab so you can get the help you need to get and stay sober.

Check Your Coverage

This might surprise you, but you have more coverage than you think. Usually, health insurance for addiction treatment will cover the following at approved facilities:

Medical Detox and Medications

Most people require medical detox. This means you will stay in a detox facility while you get the drug or alcohol toxins out of your system. If you experience extreme withdrawal symptoms from some drugs and alcohol, you’ll receive medical supervision through the detox period.

Inpatient or Residential Care

You will live at the treatment facility in safe and secure surroundings with 24-hour medical supervision. This program is important for people with a severe addiction and a possible co-occurring mental issue.

Outpatient Care

If you participate in an outpatient program, you will live at home and attend counseling and therapy sessions at the facility during the day. This is good if your addiction problem is not severe or if you have already completed a more intense level of care.

Dual Diagnosis

As mentioned previously, it is critical for co-occurring mental health and substance use disorders to be treated together. Failure to do so will make the untreated condition get worse.

Continued Care

After completing a treatment program, people should keep attending therapy sessions. This is a major aid in preventing a relapse. Some people who feel they aren’t ready to go back to living a substance-free life will enter a sober living home. They will reside with other recovering addicts in a drug-free residence with structured rules and mutual support.

Maintenance Medication

Some addictions require medication to maintain sobriety for some time. This helps typically to prevent cravings and ultimately, a relapse.

Understanding Insurance Terms

Getting denied for mental health or substance use treatment is frustrating. Part of what makes it so stressful is the terminology insurance companies use. Some of the most common terms are:

  • Medical necessity standards are used by the insurance company to determine whether the treatment recommended by your mental health care provider are reasonable, necessary, and appropriate. If treatment is medically necessary, it will be covered.
  • Utilization management is a process that insurers use to decide if the requested care is medically necessary and in line with accepted medical practice. This means it’s proven to be effective.
  • Prior authorization is also known as pre-approval. This is when you or your care provider must ask for approval before your health plan will cover a service, treatment plan, or prescription drug. 
  • Step therapy is a kind of prior authorization in which you must try a less expensive drug or service before you can move to the more expensive prescription or service.

If you are denied coverage, you may appeal the decision. Remember, mental parity is the equal treatment of mental and other health conditions under insurance plans. Most health plans are required to follow federal and state parity laws.

You will need to check your coverage or let us check for you. We can relieve some of the stress you may be experiencing at this time. Different companies cover different levels of treatment services, and we are glad to help you sort it out.

Paying for Rehab at Harmony Ridge Recovery Center

We have insurance and admissions specialists that can help you arrange for financing of your rehab at Harmony Ridge. 

  • Private insurance: Harmony Ridge accepts most major insurance plans.
  • Self-pay: Sometimes the insurance company doesn’t pay the entire cost of rehab. Some people would rather pay the total expense on their own and not involve their insurance company.
  • Personal loan: You may be able to obtain a loan from your bank or use a credit card. Occasionally, family members believe it’s worthwhile to help with a loan for rehab. There are also special healthcare credit cards with deferred interest that you can use.
  • Medicaid: Medicaid is a federal program that provides medical coverage for low-income individuals and families, the elderly, and pregnant women. Harmony Ridge is one of the only Medicaid-approved facilities in West Virginia.

If You Have Questions, Harmony Ridge Has Answers

Deciding on treatment is a major life decision. We are glad you are going to take care of yourself or help a loved one. Our dedicated staff will make you and your recovery a priority with treatment programs specifically for you.

Our facility is located in the beautiful Mid-Ohio Valley with 50 acres of peace and serenity so you can truly concentrate on getting well. Contact us today. We are always here for you.

References:

www.hhs.gov/about/agencies/advisory-committees/mental-health-parity

www.helpguide.org

www.healthcare.gov

www.nami.org